Medica Direct HSA SM. Health plans as individual as you and your family. Medica Direct

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Medica Direct HSA SM. Health plans as individual as you and your family. Medica Direct"

Transcription

1 SOUTH DAKOTA Medica Direct HSA SM Health plans as individual as you and your family. Medica Direct HSA SM High-deductible health plans designed to work with an optional health savings account. For coverage beginning February 1, 2010 or later.

2 The affordable health plan with tax advantages. Lower premiums. Attractive tax savings. Greater financial control. This is Medica Direct HSA, the affordable health plan designed for those who are paying their own way. It s the plan that gives you the choices and tools you need to spend your health care dollars the way you want wisely. A health savings account (HSA) plan combines aspects of your health coverage with sound financial planning. A high deductible plan makes your premium more affordable while protecting you from major medical bills. A personal health savings account (HSA) helps pay your deductible while offering federal tax benefits. Choose the affordable Medica Direct HSA plan, and start taking charge of your health care decisions today. We ve made affordability a choice. Medica Direct HSA is a high deductible health plan with various deductible and coinsurance options. The plan offers prescription benefits, coverage for preventive care, major medical expenses and access to our extensive provider network. Please see the Outline of Coverage in this brochure for specific details about our product offerings. -2-

3 A plan with tax advantages. The Medica Direct HSA high deductible plan gives you the option to open a federally qualified health savings account (HSA). Setting aside dollars in your HSA account will give you important federal tax savings and a smart way to pay for deductibles, coinsurance, and qualified out-of-pocket medical costs. While you can choose any qualified organization to administer your account and investment of funds, Medica has simplified the process by working with industry leaders to offer ease of enrollment and discounted pricing. Getting started is as easy as visiting medica.com. Once there, click on Medica Products, then click on Medica Direct HSA. Medica Direct HSA Instead of paying all costs towards one traditional plan High deductible plan reduces premium costs Deposit the cost savings into your HSA account Fund flexibility gives you control. With an HSA, you control the money in your account. Because your funds are portable, they move with you if you retire, take a job or switch plans. You can make contributions until April 15 following the plan year, and use your funds to pay for things like: Health care deductibles and coinsurance. IRS Section 213(d) eligible medical expenses, such as: Qualified long-term care services Eyeglasses, contact lenses and contact lens solution needed for medical reasons Laser eye surgery Chiropractic care Dental treatment Prescription and over-the-counter medications For a complete list of 213(d) eligible expenses contained in IRS Publication 502, go to Qualified long-term care insurance or COBRA coverage. At retirement to pay uncovered Medicare expenses and certain Medicare premiums. Non-eligible expenses are subject to IRS penalty and tax. -3-

4 Visit MainStreetMedica.com for important online tools. This resource can help you stay in control and make informed decisions, including: Personalized health information for each covered family member. Decision-support tools: Treatment cost estimator you choose how much to spend Quality data on hospitals, physicians, clinics, radiology centers, surgery centers, pharmacies and other health care providers Health-related news and articles Medica s List of Preferred Drugs (formulary). Find A Doctor locator. Be covered when you re away with our Travel Program. You can receive Medica-style coverage when you travel in the United States but outside of Medica s service area so long as you use a Travel Program provider. Transplant services are not included in this expanded national coverage. Find more Travel Program information at medica.com: Click on Medica Products Click on Medica Direct HSA Scroll down to Find A Doctor Click on Travel Program -4-

5 How to enroll in Medica Direct HSA Complete the Medica Direct HSA enrollment application. You will need to choose single or family coverage, your level of coverage (80% or 100%), and your deductible level. Fill out the application completely. Eligibility is determined by Medica. This includes the requirements that you must be a U.S. citizen and not eligible for Medicare. Also, you must reside in Medica s South Dakota service area. Include all dependents (if any) to be covered on the application. Include your initial monthly premium check or money order payment with the application. Your application will not be accepted if payment is not received in full. Refer to the premium chart when calculating your premium or contact Medica to determine your rate. Then simply return your completed application and payment to Medica in the enclosed pre-paid envelope. If you want to establish an HSA account, you may choose any qualified trustee. Medica has established relationships with industry leaders. For more information, please visit medica.com. Once there, click on Medica Products, then click on Medica Direct HSA for Individuals. You are not required to use any particular HSA administrator in order to utilize the Medica health plan, and setting up an HSA is always optional. What about pre-existing conditions? Pre-existing conditions that you had within the 6 months before your enrollment date may not be covered during the first 12 months following your enrollment date. However, if you have maintained continuous health care coverage, the pre-existing condition limitation applies during the first 12 months following your enrollment date. In addition, this 12-month period may be reduced by the amount of time you maintained qualifying coverage before your enrollment date. Learn more. For specific details regarding your deductible and benefit options, please see the Summary of Benefits contained in this brochure. The materials included in this packet are not meant to be all-inclusive. For more information simply give us a call at or A Medica sales person will be on hand Monday through Thursday, 8 a.m. to 5 p.m., and Friday from 9 a.m. to 5 p.m. You can also visit us online at medica.com. -5-

6 Medica Direct HSA South Dakota An Outline of Coverage to help you understand your high deductible health plan coverage. The following is an Outline of Coverage for the Medica Direct HSA plan. It is a high level overview and not meant to be all-inclusive. If you have questions, contact your Medica broker or call Medica s Sales Department at or OUTLINE OF COVERAGE You should read your policy carefully. This Outline of Coverage provides a very brief description of the important features of your policy. This is not the insurance contract and only the actual policy provisions will determine your benefits. The policy itself sets forth in detail the rights and obligations of both you and Medica Insurance Company. It is therefore important that you read your policy carefully. Lifetime maximum per person Office visits for sickness, injury, screenings and physicals Inpatient and outpatient X-ray and lab services Inpatient and outpatient hospital services Emergency room care and ambulance service Medical supplies Chiropractic, occupational, physical and speech therapy Well-child services to age 6, immunizations to age 18 Home health care up to $25,000 a year Formulary prescription drugs Mental health services (treatment of biologically based illness) Treatment of alcoholism (coverage is limited to a maximum of 30 days care in any 6 consecutive month period and a lifetime maximum of 90 days of care) Maternity (delivery and post-delivery care) Skilled nursing services (120 days per year limit) -6- Note: Pre-existing conditions that you had within the six months before your enrollment date may not be covered during the first 12 months following your enrollment date. However, if you have maintained continuous health care coverage, the pre-existing condition limitation applies during the first 12 months following your enrollment date. In addition, this 12-month period may be reduced by the amount of time you maintained qualifying coverage before your enrollment date.

7 80% Plans Deductible* Single $1,500 $1,900 Family $3,000 $3,850 Out-of-pocket maximum** $2,700 $3,100 $4,050 $4,850 A family must meet the entire deductible before any benefits will be paid, except where noted. 100% Plans Deductible* Single $2,300 $3,000 Family $4,450 $5,750 Out-of-pocket maximum** $2,300 $3,000 $4,450 $5,750 A family must meet the entire deductible before any benefits will be paid, except where noted. $5 million $5 million First 18 months, 0% coverage; thereafter, 80% after deductible First 18 months, 0% coverage; thereafter, 100% after deductible * Any portion of the yearly deductible satisfied during the last three months of a calendar year (October, November or December) can be applied toward the next calendar year s deductible. * You receive the highest level of benefits and the lowest out-of-pocket costs when you use a network provider. If you choose to receive services from a non-network provider, you will be responsible for any deductible and coinsurance, and the difference between Medica s non-network reimbursement amount (generally based on a fee schedule) and the non-network provider s billed charges. This is only a summary. Your policy will provide a detailed description of what is and is not covered. -7-

8 Authorization Requirements Prior Authorization Prior authorization from Medica Insurance Company (MIC) may be required before you receive certain services or supplies in order to determine whether a particular service or supply is medically necessary and a benefit. MIC uses written procedures and criteria when reviewing your request for prior authorization. To request prior authorization for a service or supply, either you, your representative, or your attending provider must call MIC. Some of the services that may require prior authorization from MIC include: Reconstructive or restorative surgery Organ and bone marrow transplant Home health care Medical supplies and durable medical equipment Outpatient surgical procedures Skilled nursing facility services In-network benefits for services from non-network providers Referrals Certain health services are covered only upon referral. All referrals to non-network providers and certain types of network providers must be prior authorized by MIC to be eligible for coverage at your highest level of benefits. In particular, MIC will arrange for mental health services and treatment of alcoholism benefits. MIC uses a limited network of hospitals for the provision of mental health and treatment of alcoholism benefits. Premiums, Renewability and Continuation of Coverage Premium Payment of premium is due on the first day of each calendar month. The grace period for the subscriber s payment of monthly premiums will be 31 days from the date a premium is due. If you pay the premium at any time during this grace period, your policy shall remain in force. If premium is not paid by the end of the grace period, coverage will end as of the last day of month through which you have paid. Medica Insurance Company may change this premium during the year with 30 days written notice to you. Premiums are subject to change one time within a 12 month period, for the entire block of business. The following factors will be reflected in your individual rates: Individual demographics including age, gender, family composition and tobacco use Health status of the block of business as determined by the claims experience for the block of business The expected increase in the overall cost of health care Continuation South Dakota law requires that a covered dependent spouse be offered the opportunity to pay for an extension of health coverage (called continuation coverage) in certain instances where health coverage would otherwise end. The subscriber s covered dependent spouse has the right to continuation coverage if he or she loses coverage under the Policy for either of the following reasons: a) divorce from the subscriber; or b) the subscriber s eligibility for Medicare or security disability benefits. -8-

9 Exclusions The following services, supplies and associated expenses are not covered under this plan. This is not a complete list. Please consult the policy for more detail. GENERAL EXCLUSIONS 1. Services that are not medically necessary. This includes but is not limited to services inconsistent with the medical standards and accepted practice parameters of the community and services inappropriate in terms of type, frequency, level, setting, and duration to the diagnosis or condition. 2. Services or drugs used to treat conditions that are cosmetic in nature, unless otherwise determined to be reconstructive. 3. A drug, device or medical treatment or procedure that is investigative. 4. Services for genetic screening and testing except when: a. Recommended by a genetic counselor as predictive of a disease process, and treatment standards of care exist for the disease process; or b. Reproductive choices would be made based on the test findings. 5. Nutritional and electrolyte substances. 6. Physical or occupational or speech therapy when there is no reasonable expectation that the condition will improve over a predictable period of time. 7. Neuropsychological evaluations/cognitive testing, except for the diagnosis or treatment of a medical illness or injury. 8. Custodial care, unskilled nursing or unskilled rehabilitation services. 9. Respite or rest care except for Hospice Services. 10. Services for which benefits have been paid under worker s compensation, employer liability, or any similar law. 11. Services received before coverage under this Policy becomes effective. 12. Services received after coverage under this Policy ends. 13. Services prohibited by law or regulation, or illegal under South Dakota law. 14. Services to treat injuries that occur while on military duty, and any services received as a result of war, or any act of war (whether declared or undeclared). 15. Exams, other evaluations or other services for employment, insurance, or licensure, unless otherwise covered by MIC. 16. Exams, other evaluations or other services for judicial or administrative proceedings or research, except emergency examination of a child ordered by judicial authorities, or which MIC determines is medically necessary, or as otherwise covered by MIC under this Policy. 17. Services not received from or under the direction of a physician. 18. Services for or related to intensive behavior therapy treatment programs for the treatment of autism spectrum disorders. Examples of such services include, but are not limited to, Intensive Early Intervention Behavior Therapy Services (IEIBTS), Intensive Behavioral Intervention (IBI), and Lovaas therapy. 19. Infertility services and services and drugs for or related to assisted reproductive technology (ART), artificial insemination or in vitro fertilization. 20. Charges for services by a non-network provider in excess of the non-network provider reimbursement amount. 21. Maternity care services during the first 18 months following your enrollment date. 22. Implants for the purpose of contraception. 23. Therapeutic acupuncture. 24. Services billed by acupuncturist. 25. Growth hormone. 26. Services to treat a pre-existing condition. 27. Services and supplies to the extent paid or payable under Medicare. 28. Services provided to your dependents if you have subscriber coverage only. 29. Charges that are eligible, paid, or payable under any medical payment, personal injury protection, automobile or other coverage that is payable without regard to fault, including charges that are applied toward any deductible, or coinsurance requirement of such coverage. 30. Services for private-duty nursing. 31. Functional capacity evaluations and related services for vocational purposes or for determination of disability or pension benefits. 32. Services for chemotherapy, supplies, drugs, and aftercare in connection with a human organ transplant that is not covered. 33. Services for or in connection with fetal tissue transplantation. 34. Services which are not within the scope of licensure or certification of the provider. 35. Services received outside the United States. 36. Charges for giving injections which can be self-administered. 37. Services for a mental illness that is not a biologically-based mental illness. 38. Relationship counseling beyond initial evaluation and brief intervention services. -9-

10 A glossary of terms for the times when you need clarity. HIGH DEDUCTIBLE HEALTH PLAN A High Deductible Health Plan (HDHP) is a health insurance plan with a minimum deductible (in 2010) of $1,200 (self-only coverage) or $2,400 (family coverage). The annual out-of-pocket (including deductibles and copays) cannot exceed $5,950 (self-only coverage) or $11,900 (family coverage). These guidelines are set by federal law. The dollar limits will be adjusted for inflation each year. An HDHP with a fourth quarter deductible carryover benefit (such as Medica Direct HSA) must have a deductible at least 25 percent higher than the standard minimum. COINSURANCE Coinsurance is the percentage amount of eligible charges you are responsible to pay the provider after you have met your deductible. If you select the 80 percent coinsurance plan, Medica Direct HSA plan pays 80 percent for all eligible charges for covered services obtained from network providers and non-network providers. The remaining percentage amount of normally 20 percent is your coinsurance. PROVIDER NETWORK Medica has an extensive provider network. There is a good chance your current physician is part of the network. You receive the highest level of benefits and lower out-of-pocket expenses when you use network providers. Call Medica CallLink at or visit us at medica.com to see if your doctor is in our network. Medica does not want to get between you and your physician, so in most circumstances, we do not require our members to obtain prior approval to obtain coverage for services from non-network providers. You can seek services from providers who are not contracted with Medica, but you will be required to pay the difference between Medica s non-network reimbursement amount (generally based on a fee schedule) and the charges your non-network provider bills (in addition to the deductible and coinsurance). This amount will not count towards your deductible or out-of-pocket maximum. ELIGIBLE CHARGES Medica Direct HSA eligible charges are generally paid based on Medica s fee schedule. This is the amount that Medica s network providers have agreed to accept for eligible services rendered to Medica members. If you receive services from a non-network provider, you will also pay the difference between Medica s non-network reimbursement amount (generally based on a fee schedule) and the charges your non-network provider bills. If you have the 80% coinsurance plan, you will also be required to pay your 20% coinsurance. This amount could be significant and will not count towards your deductible or out-of-pocket maximum. DRUG FORMULARY The Medica Formulary is a list of generic and brand name outpatient prescription medications which are covered. A team of physicians and pharmacists meet regularly to review and update the list to be sure the Formulary remains responsive to the needs of our members and providers throughout the year. Your doctor can use this list to select covered medications for your health care needs, while helping you maximize your prescription drug benefit. If you use a network pharmacy and your prescribed drug is on Medica s Formulary, the prescription will be filled and dispensed to you for your applicable copayment or coinsurance. As with all drugs, your doctor will need to determine if a generic drug is the best drug for you to take. If the prescribed drug is not on the Formulary, you are responsible for the cost of the drug. In some instances, you can request a Formulary exception through Medica s Formulary Exception process. -10-

11 Contact us. For more information or to locate a Medica broker to assist you, contact Medica at: or TTY: or a.m. 5 p.m. Monday Thursday 9 a.m. 5 p.m. Friday You may also visit us at medica.com or us at -11-

12 Medica Direct Health plans as individual as you and your family. PO Box 9310, Minneapolis, MN Medica. Medica is a registered service mark of Medica Health Plans. Medica refers to the family of health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin, Medica Insurance Company, Medica Self-Insured and Medica Health Management, LLC. Medica Direct HSA SM is a service mark of Medica. CHA

Minnesota Comprehensive Health Association. Summary of Benefits and Plan Options

Minnesota Comprehensive Health Association. Summary of Benefits and Plan Options Minnesota Comprehensive Health Association Summary of Benefits and Options www.mchamn.com MCHA Customer Service 1-866-894-8053 TTY: 952-992-3190 or toll-free at 1-800-841-6753 Monday Friday: 7 a.m. 6 p.m.

More information

High Deductible and HSA Qualified Plans

High Deductible and HSA Qualified Plans High Deductible and HSA Qualified Plans For individuals and families HIGH DEDUCTIBLE PLANS Insuring Minnesota One Life At A Time w w w.preferredone.com Dear Prospective Members: Thank you for your interest

More information

DRAKE UNIVERSITY HEALTH PLAN

DRAKE UNIVERSITY HEALTH PLAN DRAKE UNIVERSITY HEALTH PLAN Effective Date: 1/1/2015 This is a general description of coverage. It is not a statement of contract. Actual coverage is subject to terms and the conditions specified in the

More information

Consider Alternative Solutions if:

Consider Alternative Solutions if: Alternative Solutions is a group association fixed indemnity health insurance plan underwritten by Madison National Life Insurance Company, Inc., a Wisconsin insurance company. Madison National Life is

More information

Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan

Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary High Deductible Health Plan General Provisions Deductible (eligible medical and prescription drug expenses apply to the deductible) Kraft Foods Group, Inc. Retiree Medical and Prescription Plan Summary Care can be obtained in-network

More information

Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan

Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan From the Minnesota Comprehensive Health Association (MCHA) PO Box 9310 Minneapolis, Minnesota 55440-9310 Beginning

More information

Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan

Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan Disclosure Information and Summary of Benefits for the Basic Medicare Supplement Plan From the Minnesota Comprehensive Health Association (MCHA) PO Box 9310 Minneapolis, Minnesota 55440-9310 Beginning

More information

Options Blue affordable coverage with a tax-advantaged account

Options Blue affordable coverage with a tax-advantaged account Options Blue SM Options Blue affordable coverage with a tax-advantaged account A smart move for individuals and families who like to plan and save 2010 The health plans that help you save money Options

More information

Aetna Whole Health Houston, TX: ES Coverage Period: 01/01/2014 12/31/2014

Aetna Whole Health Houston, TX: ES Coverage Period: 01/01/2014 12/31/2014 This is only a summary. Please read the FEHB Plan brochure RI 73-873 that contains the complete terms of this plan. All benefits are subject to the definitions, limitations, and exclusions set forth in

More information

Basic Fixed indemnity health insurance for individuals and families

Basic Fixed indemnity health insurance for individuals and families Basic Fixed indemnity health insurance for individuals and families Basic is a group association fixed indemnity health insurance plan underwritten by Madison National Life Insurance Company, Inc., a Wisconsin

More information

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective 7/1/2015 SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Laramie County School District 2 Open Access Plus Base - Effective General Services In-Network Out-of-Network Physician office visit Urgent care

More information

Bates College Effective date: 01-01-2010 HMO - Maine PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK PLAN FEATURES

Bates College Effective date: 01-01-2010 HMO - Maine PLAN DESIGN AND BENEFITS PROVIDED BY AETNA HEALTH INC. - FULL RISK PLAN FEATURES PLAN FEATURES Deductible (per calendar year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. Once Family Deductible is met, all family

More information

Coverage level: Employee/Retiree Only Plan Type: EPO

Coverage level: Employee/Retiree Only Plan Type: EPO This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan documents at www.dbm.maryland.gov/benefits or by calling 410-767-4775

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: UnitedHealthcare Life Ins Co: Platinum Copay Select Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family

More information

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services?

Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? : VIVA HEALTH Access Plan Coverage Period: 01/01/2015 12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document

More information

Covered 100% No deductible Not Applicable (exam, related tests and x-rays, immunizations, pap smears, mammography and screening tests)

Covered 100% No deductible Not Applicable (exam, related tests and x-rays, immunizations, pap smears, mammography and screening tests) A AmeriHealth EPO Individual Summary of Benefits Value Network IHC EPO $30/50% Benefit Network Non network Benefit Period+ Calendar year Individual deductible $2,500 Family deductible $5,000 50% Individual

More information

Answers. Why this Matters:

Answers. Why this Matters: Aetna HDHP What is the overall deductible? Do I need a referral to see a specialist? Are there this plan doesn't cover? Yes. This is only a summary. If you want more details about your coverage and costs,

More information

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015

SUMMARY OF BENEFITS. Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective 1/1/2015 SUMMARY OF BENEFITS Cigna Health and Life Insurance Co. Grand County Open Access Plus Effective General Services In-Network Out-of-Network Primary care physician You pay $25 copay per visit Physician office

More information

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA)

THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) THE MITRE CORPORATION PPO High Deductible Plan with a Health Saving Account (HSA) Effective Date: 01-01-2016 PLAN FEATURES Annual Deductible $1,500 Employee $3,000 Employee $3,000 Employee + 1 Dependent

More information

Supplemental Medical Plan Your Kaiser Foundation Health Plan (KFHP) or Kaiser Employee Medical Health Plan (KEMHP) provides

Supplemental Medical Plan Your Kaiser Foundation Health Plan (KFHP) or Kaiser Employee Medical Health Plan (KEMHP) provides Supplemental Medical Plan Your Kaiser Foundation Health Plan (KFHP) or Kaiser Employee Medical Health Plan (KEMHP) provides basic medical coverage. The Supplemental Medical Plan covers certain medical

More information

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944

PLAN DESIGN AND BENEFITS POS Open Access Plan 1944 PLAN FEATURES PARTICIPATING Deductible (per calendar year) $3,000 Individual $9,000 Family $4,000 Individual $12,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being

More information

Bowling Green State University : Plan B Summary of Benefits and Coverage: What This Plan Covers & What it Costs

Bowling Green State University : Plan B Summary of Benefits and Coverage: What This Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at MedMutual.com/SBC or by calling 800.540.2583. Important Questions

More information

NO DEDUCTIBLE FOR MANY SERVICES

NO DEDUCTIBLE FOR MANY SERVICES KAISER PERMANENTE FOR INDIVIDUALS AND FAMILIES Deductible Plans How Deductible plans work Deductible plans generally offer lower monthly premiums in exchange for higher out-of-pocket payments for covered

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: UnitedHealthcare Life Ins Co: Platinum Copay Select Coverage Period: Beginning on or after 01/01/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual/Family

More information

PRE-EXISTING CONDITION INSURANCE POOL ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY

PRE-EXISTING CONDITION INSURANCE POOL ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY PRE-EXISTING CONDITION INSURANCE POOL ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY Administered By: The Arkansas Comprehensive Health Insurance Pool ( CHIP ) and its subcontractor, BlueAdvantage

More information

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014

Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare. Annual Notice of Changes for 2014 Essentials Rx 15 (HMO) Plan offered by PacificSource Medicare Annual Notice of Changes for 2014 You are currently enrolled as a member of Essentials Rx 15 (HMO) Plan. Next year, there will be some changes

More information

FASHION INSTITUTE OF TECHNOLOGY : Aetna Open Access Elect Choice

FASHION INSTITUTE OF TECHNOLOGY : Aetna Open Access Elect Choice This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-888-982-3862.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Student Employee Health Plan: NYS Health Insurance Program Coverage Period: 01/01/2015 12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual or Family

More information

Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA

Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Regence BlueCross BlueShield of Utah: Regence Direct Silver HSA Coverage Period: 01/01/2015-12/31/2015 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual &

More information

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket Regence BlueCross BlueShield of Oregon: Preferred Coverage Period: 08/15/2015-08/14/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family

More information

HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES. Insuring Minnesota One Life At A Time. www.preferredone.com

HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES. Insuring Minnesota One Life At A Time. www.preferredone.com foreveryone HEALTH INSURANCE FOR INDIVIDUALS AND FAMILIES Insuring Minnesota One Life At A Time www.preferredone.com for EveryOne Insuring Minnesota One Life At A Time Thank you for your interest in the

More information

In-network: $5,000 per insured/ $10,000 per family per calendar year. Out-of-network: $10,000 per insured / $20,000

In-network: $5,000 per insured/ $10,000 per family per calendar year. Out-of-network: $10,000 per insured / $20,000 Regence BlueShield of Idaho: Coverage Period: Beginning on or after 01/01/2014 Regence Individual Direct Bronze HSA Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for:

More information

Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters:

Coverage for: Individual, Family Plan Type: PPO. Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bbsionline.com or by calling 1-866-927-2200. Important

More information

Aetna Open Access Managed Choice - NJ

Aetna Open Access Managed Choice - NJ This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-888-982-3862.

More information

Benefit Summary - A, G, C, E, Y, J and M

Benefit Summary - A, G, C, E, Y, J and M Benefit Summary - A, G, C, E, Y, J and M Benefit Year: Calendar Year Payment for Services Deductible Individual $600 $1,200 Family (Embedded*) $1,200 $2,400 Coinsurance (the percentage amount the Covered

More information

Optional PREFERRED CARE. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived PLAN FEATURES Deductible (per plan year) $2,000 Employee $2,000 Employee $3,000 Employee + Spouse $3,000 Employee + Spouse $3,000 Employee + Child(ren) $3,000 Employee + Child(ren) $4,000 Family $4,000

More information

Greater Tompkins County Municipal Health Insurance Consortium

Greater Tompkins County Municipal Health Insurance Consortium WHO IS COVERED Requires both Medicare A & B enrollment. Type of Coverage Offered Single only Single only MEDICAL NECESSITY Pre-Certification Requirement None None Medical Benefit Management Program Not

More information

Insurance Benefits For Employees C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S

Insurance Benefits For Employees C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S CCPS Insurance Benefits For Employees 2015 C H E S T E R F I E L D C O U N T Y P U B L I C S C H O O L S CHESTERFIELD COUNTY PUBLIC SCHOOLS BENEFITS DEPARTMENT Enrollment or Changes in Coverage 748-1226,

More information

Board of Huron County Commissioners : BASIC

Board of Huron County Commissioners : BASIC This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at MedMutual.com/SBC or by calling 800.540.2583. Important Questions

More information

Pacific Union College: Base Buy-Up Plan Option Coverage Period: 07/01/2015 06/30/2016

Pacific Union College: Base Buy-Up Plan Option Coverage Period: 07/01/2015 06/30/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.deltahealthsystems.com or by calling the Benefits Help

More information

100% Fund Administration

100% Fund Administration FUND FEATURES HealthFund Amount $500 Employee $750 Employee + Spouse $750 Employee + Child(ren) $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at which the Fund

More information

Regence BluePoint 20/40 Plan Highlights For Groups of 51+ 1/1/2015

Regence BluePoint 20/40 Plan Highlights For Groups of 51+ 1/1/2015 Plan Features Provider choice: Members have direct access to their choice of providers. Coinsurance levels are lowest for In Network providers. If a member chooses an Out of Network provider, the member

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://www.cs.ny.gov/employee-benefits or by calling 1-877-7-NYSHIP

More information

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.uhs.wisc.edu/ship or by calling 1-866-796-7899. Important

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at https://eoc.anthem.com/eocdps/aso or by calling 1-888-650-4047.

More information

$6,350 Individual $12,700 Individual

$6,350 Individual $12,700 Individual PLAN FEATURES IN-NETWORK OUT-OF-NETWORK Deductible $5,000 Individual $10,000 Individual $10,000 Family $20,000 Family All covered expenses accumulate separately toward the preferred or non-preferred Deductible.

More information

SHORT-TERM MEDICAL INSURANCE COVERAGE FOR 30, 60, OR 90 DAYS

SHORT-TERM MEDICAL INSURANCE COVERAGE FOR 30, 60, OR 90 DAYS SHORT-TERM MEDICAL INSURANCE COVERAGE FOR 30, 60, OR 90 DAYS TEMPORARY HEALTH INSURANCE COVERAGE FOR THOSE WHO ARE: ¾ Between Jobs ¾ Graduating from School ¾ Looking for a Lower Cost Alternative to COBRA

More information

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket

What is the overall deductible? Are there other deductibles for specific services? Is there an out-ofpocket Regence BlueShield: Regence Direct Gold with Dental, Vision, Individual Assistance Program Coverage Period: Beginning on or after 01/01/2014 Summary of Benefits and Coverage: What this Plan Covers & What

More information

PRE-EXISTING CONDITION INSURANCE PLAN ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY

PRE-EXISTING CONDITION INSURANCE PLAN ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY PRE-EXISTING CONDITION INSURANCE PLAN ( PCIP ) COMPREHENSIVE MAJOR MEDICAL EXPENSE POLICY Administered By: The Arkansas Comprehensive Health Insurance Pool ( CHIP ) and its subcontractor, BlueAdvantage

More information

NATIONAL HEALTH CARE, INC. : Aetna HealthFund Aetna Choice POS II - HSA Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs

NATIONAL HEALTH CARE, INC. : Aetna HealthFund Aetna Choice POS II - HSA Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs : This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-888-982-3862.

More information

HSA-QUALIFIED DEDUCTIBLE Plans What is an HSA-qualified deductible plan? How does it work? Features at a glance

HSA-QUALIFIED DEDUCTIBLE Plans What is an HSA-qualified deductible plan? How does it work? Features at a glance HSA-QUALIFIED DEDUCTIBLE Plans What is an HSA-qualified deductible plan? How does it work? Features at a glance HSA-QUALIFIED DEDUCTIBLE PLANS Are you interested in balancing your health and your finances?

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Anthem BlueCross BlueShield WI 2-99 Lumenos Health Savings Account POS Copay Option 4 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 12/01/2014-11/30/2015 Coverage

More information

National Guardian Life Insurance Company: Rider University International Student Health Insurance Plan Coverage Period: 08/20/2015-08/20/2016

National Guardian Life Insurance Company: Rider University International Student Health Insurance Plan Coverage Period: 08/20/2015-08/20/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Every New Hampshire Resident Qualifies For Health Insurance. About NHHP. Eligibility

Every New Hampshire Resident Qualifies For Health Insurance. About NHHP. Eligibility About NHHP New Hampshire Health Plan (NHHP) is a non-profit organization formed by the New Hampshire legislature. NHHP provides health coverage to New Hampshire residents who otherwise may have trouble

More information

Blueprint. A self-funded health program for small employer groups

Blueprint. A self-funded health program for small employer groups Blueprint A self-funded health program for small employer groups Blueprint provides a program to establish and maintain a self-funded health plan coordinated with stop-loss insurance protection for employers

More information

BATES COLLEGE : Aetna HealthFund Open Choice - Consumer Choice HSA

BATES COLLEGE : Aetna HealthFund Open Choice - Consumer Choice HSA This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-855-586-6963.

More information

Commercial. Individual & Family Plan. Health Net California Farm Bureau and PPO. Insurance Plans. Outline of Coverage and Exclusions and Limitations

Commercial. Individual & Family Plan. Health Net California Farm Bureau and PPO. Insurance Plans. Outline of Coverage and Exclusions and Limitations Commercial Individual & Family Plan Health Net California Farm Bureau and PPO Insurance Plans Outline of Coverage and Exclusions and Limitations Table of Contents Health Plans Outline of coverage 1 Read

More information

BridgeSpan Health Company: BridgeSpan Oregon Standard Gold Plan MyChoice Northwest

BridgeSpan Health Company: BridgeSpan Oregon Standard Gold Plan MyChoice Northwest BridgeSpan Health Company: BridgeSpan Oregon Standard Gold Plan MyChoice Northwest Summary of Benefits and Coverage: What this Plan Covers & What it Costs Questions: Call 1 (855) 857-9943 or visit us at

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Open Choice Coverage Period: 01/01/2014-12/31/2014

Open Choice Coverage Period: 01/01/2014-12/31/2014 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-800-367-6276.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: Anthem BlueCross BlueShield Blue Access PPO Option D58 / Rx Option 8 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 12/01/2013-11/30/2014 Coverage For: Individual/Family

More information

Blue Care Elect Saver with Coinsurance Northeastern University HDHP Coverage Period: on or after 01/01/2016

Blue Care Elect Saver with Coinsurance Northeastern University HDHP Coverage Period: on or after 01/01/2016 Blue Care Elect Saver with Coinsurance Northeastern University HDHP Coverage Period: on or after 01/01/2016 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual

More information

Companion Life Insurance Company: Middlebury College Student Health Insurance Plan Coverage Period: 08/15/2015-08/14/2016

Companion Life Insurance Company: Middlebury College Student Health Insurance Plan Coverage Period: 08/15/2015-08/14/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: HealthKeepers Anthem HealthKeepers 20 POS / $10/$20/$35/20% Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage For: Individual/Family

More information

Assurant Health. Time Insurance Company. Summary of Benefits and Coverage for Assurant Health individual major medical Silver plans

Assurant Health. Time Insurance Company. Summary of Benefits and Coverage for Assurant Health individual major medical Silver plans Assurant Health Time Insurance Company Summary of Benefits and Coverage for Assurant Health individual major medical Silver plans View Summary of Benefits and Coverage for an individual plan View Summary

More information

Employee + 2 Dependents

Employee + 2 Dependents FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance Percentage at

More information

THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA)

THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA) THE MITRE CORPORATION High Deductible Health Plan (HDHP) with a Health Saving Account (HSA) PLAN FEATURES Deductible (per calendar year) $1,500 Employee $3,000 Employee $3,000 Employee + 1 Dependent$6,000

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.consumersmutual.org or by calling 1-877-371-9112. Important

More information

PLAN DESIGN AND BENEFITS - PA Health Network Option AHF HRA 1.3. Fund Pays Member Responsibility

PLAN DESIGN AND BENEFITS - PA Health Network Option AHF HRA 1.3. Fund Pays Member Responsibility HEALTHFUND PLAN FEATURES HealthFund Amount (Per plan year. Fund changes between tiers requires a life status change qualifying event.) Fund Coinsurance (Percentage at which the Fund will reimburse) Fund

More information

Administered by Capital BlueCross 1

Administered by Capital BlueCross 1 Administered by Capital BlueCross 1 PPO HRA Plan/Rx Plan This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at

More information

Medical Plan - Healthfund

Medical Plan - Healthfund 18 Medical Plan - Healthfund Oklahoma City Community College Effective Date: 07-01-2010 Aetna HealthFund Open Choice (PPO) - Oklahoma PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY -

More information

GEHA 2014. Health Savings AdvantageSM High-deductible health plan with a health savings account (HSA) (800) 821-6136 geha.com

GEHA 2014. Health Savings AdvantageSM High-deductible health plan with a health savings account (HSA) (800) 821-6136 geha.com GEHA 2014 Health Savings AdvantageSM High-deductible health plan with a health savings account (HSA) (800) 821-6136 geha.com CODE Self Only 341 Self + Family 342 Enrollment checklist 1. Research health

More information

You can see the specialist you choose without permission from this plan.

You can see the specialist you choose without permission from this plan. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.pekininsurance.com or by calling 1-800-371-9622. Important

More information

Important Questions Answers Why this Matters: Preferred Provider: $1,000 per Person/2,000 Family

Important Questions Answers Why this Matters: Preferred Provider: $1,000 per Person/2,000 Family This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.wpsic.com or by calling 1-888-915-4001. Important Questions

More information

HUMANA HEALTH PLAN, INC./HUMANA INSURANCE COMPANY: IN LG NPOS 11 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

HUMANA HEALTH PLAN, INC./HUMANA INSURANCE COMPANY: IN LG NPOS 11 Summary of Benefits and Coverage: What this Plan Covers & What it Costs SBC0041W082720130944 HUMANA HEALTH PLAN, INC./HUMANA INSURANCE COMPANY: IN LG NPOS 11 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Date: Beginning on or after 01/01/2015

More information

Important Questions Answers Why this Matters: What is the overall deductible?

Important Questions Answers Why this Matters: What is the overall deductible? Important Questions Answers Why this Matters: What is the overall deductible? Are there other deductibles for specific services? Is there an out of pocket limit on my expenses? What is not included in

More information

Gundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015

Gundersen Health Plan: MN NJ Silver $2000-0% Coverage Period: 01/01/2015-12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.gundersenhealthplan.org or by calling 1-800-897-1923.

More information

: THE LASIK VISION INSTITUTE, LLC : Aetna Choice POS II - Coverage Period: 03/01/2014-02/28/2015

: THE LASIK VISION INSTITUTE, LLC : Aetna Choice POS II - Coverage Period: 03/01/2014-02/28/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-888-982-3862.

More information

Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Bronze Plan Coverage Period: Beginning on or after 01/01/2014

Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Bronze Plan Coverage Period: Beginning on or after 01/01/2014 Regence BlueCross BlueShield of Oregon: Regence Oregon Standard Bronze Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: Beginning on or after 01/01/2014 Coverage

More information

What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No.

What is the overall deductible? $250 per person/$500 per family. Are there other deductibles for specific services? No. This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.etf.wi.gov or by calling 1-877-533-5020. Important Questions

More information

State Health Plan: Savings Plan Coverage Period: 01/01/2015-12/31/2015

State Health Plan: Savings Plan Coverage Period: 01/01/2015-12/31/2015 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.eip.sc.gov or by calling 1-888-260-9430. Important Questions

More information

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company Appendix A BENEFIT PLAN Prepared Exclusively for The Dow Chemical Company What Your Plan Covers and How Benefits are Paid Choice POS II (MAP Plus Option 2 - High Deductible Health Plan (HDHP) with Prescription

More information

Secure STM. Short-term medical insurance for individuals and families

Secure STM. Short-term medical insurance for individuals and families Secure STM Short-term medical insurance for individuals and families Individual short-term medical expense insurance for Secure STM is underwritten by Standard Security Life Insurance Company of New York,

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.arml.org\benefit_programs.html or by calling 1-501-978-6137.

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description (SPD) or Plan Document at www.pebtf.org or by calling 1-800-522-7279.

More information

Health Net Life Insurance Company California Farm Bureau Members Health Insurance Plans Major Medical Expense Coverage Outline of Coverage

Health Net Life Insurance Company California Farm Bureau Members Health Insurance Plans Major Medical Expense Coverage Outline of Coverage Health Net Life Insurance Company California Farm Bureau Members Health Insurance Plans Major Medical Expense Coverage Outline of Coverage Read Your Certificate Carefully This outline of coverage provides

More information

Important Questions Answers Why this Matters:

Important Questions Answers Why this Matters: This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.cfhp.com or by calling 1-800-434-2347. Important Questions

More information

2014-2015. Hard Waiver Plan

2014-2015. Hard Waiver Plan 2014-2015 A health insurance plan specifically designed for students of Colleges and Universities in the Wisconsin Association of Independent Colleges and Universities (WAICU) Hard Waiver Plan Affordable

More information

LGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs

LGC HealthTrust: MT Blue 5-RX10/20/45 Coverage Period: 07/01/2013 06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com or by calling 1-800-870-3057. Important Questions

More information

What is the overall deductible?

What is the overall deductible? Regence BlueCross BlueShield of Oregon: HSA 2.0 Coverage Period: 07/01/2013-06/30/2014 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual & Eligible Family

More information

TRINET GROUP, INC. : Aetna Whole Health-Banner Health Network- AZ ACO-OA MC 1000/70%

TRINET GROUP, INC. : Aetna Whole Health-Banner Health Network- AZ ACO-OA MC 1000/70% This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-888-982-3862.

More information

University of Southern Indiana: Buy-Up Plan Blue Access (PPO) Coverage Period: 01/01/2015-12/31/2015

University of Southern Indiana: Buy-Up Plan Blue Access (PPO) Coverage Period: 01/01/2015-12/31/2015 University of Southern Indiana: Buy-Up Plan Blue Access (PPO) Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015 Coverage for: Individual/Family

More information

Aetna Open Access Managed Choice - HDHP 3000

Aetna Open Access Managed Choice - HDHP 3000 Important Questions Answers Why this Matters: What is the overall For each Calendar Year, In-network: You must pay all the costs up to the deductible amount before this plan deductible? Individual $3,000

More information

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO

Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO Your Plan: Anthem Silver HMO 1500/30%/6550 Your Network: California Care HMO This summary of benefits is a brief outline of coverage, designed to help you with the selection process. This summary does

More information

Anthem Blue Cross Blue Shield St. Charles School District Blue Access & Blue Access Choice PPO Base Plan Coverage Period: 01/01/2015-12/31/2015

Anthem Blue Cross Blue Shield St. Charles School District Blue Access & Blue Access Choice PPO Base Plan Coverage Period: 01/01/2015-12/31/2015 Anthem Blue Cross Blue Shield St. Charles School District Blue Access & Blue Access Choice PPO Base Plan Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage Period: 01/01/2015-12/31/2015

More information

Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016

Student Health Insurance Plan Insurance Company Coverage Period: 07/01/2015-06/30/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.studentplanscenter.com or by calling 1-800-756-3702.

More information

PDS Tech, Inc Proposed Effective Date: 01-01-2012 Aetna HealthFund Aetna Choice POS ll - ASC

PDS Tech, Inc Proposed Effective Date: 01-01-2012 Aetna HealthFund Aetna Choice POS ll - ASC FUND FEATURES HealthFund Amount $500 Individual $1,000 Employee + 1 Dependent $1,000 Employee + 2 Dependents $1,000 Family Amount contributed to the Fund by the employer Fund Coinsurance 100% Percentage

More information

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015

Benefit Coverage Chart & Rates Effective July 1, 2014 June 30, 2015 Benefit Coverage Chart & Rates Effective PPO Medical Coverage by Category The following coverages are included with the PPO plan: o Prescription o Vision Additional Benefits o Dental o Dental & Orthodontia

More information

2014-2015. Voluntary Plan

2014-2015. Voluntary Plan 2014-2015 A health insurance plan specifically designed for students of Colleges and Universities in the Wisconsin Association of Independent Colleges and Universities (WAICU) Voluntary Plan Affordable

More information